PL-08-2018Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Scheduled Inspection Date: April 23, 2009
Inspector: Levrock, James
Owner: ZIBELLI, AMY
Job Address: 920 NE 95 Street
Miami Shores, FL
Project: <NONE>
Contractor:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1132060070010
Building Department Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
April 22, 2009
Page 1 of 28
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Plumbing
Owner's Name (Fee Simple Titleholder)
Owner's Add
{�tiM 4k-J Si In
Address
Z pp/ IV E j' S S
S
City /II i`Gi�w.. art^ State �l 3 3 13 d
Tenant/Lessee Name
Permit No. ft-O '2_OU
ster Permit No.
Phone #
o3 (to/ ei-
Zip
Phone #
E -MAIL: pV-.I- c � . 1M � C
Job Address ( ere the work is being done) ? 2. (j /V' % ..� S�-
City Miami Shores Village County Miami -Dade Zip 3 3 / ' d
FOLIO /PARCEL# (f' - 3 Z. — 0 G -GCS . -co j D
Is Building Historically Designated YES NO V
Contractor's Company Name Cer .S lie / 1421 1)4 Ada Phone # C Or) S~ S`2 - / y9Z2
Contractor's Address , d'J .Q ' ij //S AG,-e ./e
City /////d4,4( State /� /e .P/ 0141 Zip a 1/.(.S-'
Qualifier Name - //ta 7y K S P 424_ Phone # (7(4) 2s-,S- S"/ .-g--
nee O/ 90.(-9
State Certificate or Registration No.
E -MAIL:
Certificate of Competency No.
Architect /Engineer's Name (if applicable) c v .. 4�1,� Phone # 7 Us 22 2 9 %c
Valq
is Permit $ S99
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteratiop ❑New,
/14 s i'r`k '
/. s
Describe Work:
Repair /Replace ❑ Demolition
* * * * * * * * * *, * * ****** * ** * **** * ** * *** ** ** Fees* * ***** ***** * ***** **** * * **** * *** ****** ** ***
Submittal Fee $
Notary $ ^r"
Scanning $
Bond $
Permit Fee $
Training /Education Fee $
Radon $ DPBR $ Zoning $
ft
0 -O
CCF $ .90 CO /CC
Technology Fee $ 4
Code Enforcement $ Double Fee $
Structural Review. $
Total Fee Now Due $ 1 4KJ
See Reverse side -4
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection, fee will be charged.
(( f
Signature 1V1i i %i J i,y1
Own Agent
Contractor
The foregoing instrument was acknowledged before me thi&?J The foregoing instrument was acknowledged before me this / 7
day ofd = , 20cq, , by rY)C,nakr &r Y1 day of 4D(/• 20vr , by /h . '/8
who is aerson own to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
iQ •
NOTARY PUBLIC -'ATE 0? FLORIDA
Chrissy Ayala
ommission DD721SQ99-
.. ,,,ss Expires: JAN. 21, 2012
BONDED THRU ATLANTIC BONDING CO., INC.
Print: .11cizsS--' �1
My Commission Expires:
*r• ***** * * ** * * * *xx xxte* * * ******** e* * *** *x' **x'>tx>;*
APPLICATION APPROVED BY: a h_..41111t r At
spy" r--
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
(Revised 02/08/06)
BEATRIZ A. BURGOS
* .., .COMMISSION it 00 6a250 EXPIRES: April 7, 2011
N,,„'' of FL, Bonded Thru Budget Notary Services
2 h ns Examiner
Engineer
Zoning